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Abscess/Furuncle
What is an abscess?
A (skin) abscess is a localized infection in the dermis. Staphylococcus aureus
is usually the causative organism but gram-negative organisms and anaerobes may
also be involved. An abscess usually results from inoculation of the organism
through broken skin that is usually caused by accidental trauma or surgery. Furuncles are
bacterial infections in which bacteria gain entry through the hair follicle with
the resultant infection and inflammation spreading to the surrounding dermis. Abscess and furuncle present similarly,
appearing as an erythematous, tender, fluctuant,
pus-filled dermal nodule. Fever is usually not present. Regional lymph
nodes may be enlarged.
Some patients have recurrent furuncles, possibly due to an
underlying factor such as immunodeficiency or diabetes, but often with no
obvious risk factor. These patients are often carriers of Staphylococcus aureus,
commonly in the nares.
With what can an abscess be confused?
Acne vulgaris and
hidradenitis suppurativa can both cause pus-filled nodules, but the
distribution and number of lesions usually makes the diagnosis obvious. The
presence of comedones also aids in the distinction.
How is an abscess diagnosed?
The diagnosis is usually obvious since few conditions cause
pus-filled nodules (see above.) Culture of purulent material obtained from
incision and drainage confirms the diagnosis. Blood cultures are not required
unless the patient appears systemically ill (i.e. septic). Biopsy is not usually
necessary.
How is an abscess treated?
Incision and drainage is necessary to open the closed space of
the abscess. This is usually curative even without antibiotics. However,
systemic antibiotics are desirable to decrease infectivity and prevent
progression of early lesions. An anti-staphylococcal antibiotic
such as dicloxacillin or cephalexin (Keflex) is required.
For patients with recurrent furuncles, application of antibiotic
ointment (e.g. bacitracin or mupirocin) to the nares may reduce bacterial
carriage. Periodic daily body scrubbing with an antiseptic solution (e.g.
chlorhexidine) may also help prevent recurrence.
What is the prognosis for an abscess?
Healing usually occurs promptly following incision and drainage
and systemic antibiotics. Large abscesses may leave a scar. Untreated lesions may
spontaneously rupture.
Date created 04/14/2007
Last updated
01/03/2009
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